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Home My WebLink AboutOwen, Mike Of SOUTyo! ELIZABETH A.NEVILLE,RMC,CMC O Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Q Southold, New York 11971 MARRIAGE OFFICER l� • �O Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1500 C FREEDOM OF INFORMATION OFFICER OUsoutholdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD pp TO: Southold Town Building Dep E C E � U E FROM: Carol Hydell, Southold Town C Of�j¢;q' 2 0 2010 D DATED: May 17, 2010 BLDG.DEPT. TOWN OF SODTHOLO RE: Cesspool Construction Applicati Transmitted herewith is a copy of application No. 3952 for a Cesspool/Septic Tank Construction Permit submitted by: Charles Thomas for Mike Owen Please review the application and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. Carol Hydell I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVEy/ DISAPPROVE Comments: Final approval required from the Suffolk County Health Department_ Signature Dated D Town Hall,53095 Main Road ELIZABETH A.NEVII.LE h'L` 'y TOWN CLERK p P.O. Box 1179 Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER • Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER y'flpl .�`�� Telephsouthol one( 1) 765-1800 6 -1 net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10_ or Non-Residential @$25 i/ Application No.'�_ 9 �� Permit No. Applicant Name e—' S 1 kyk^A!S Applicant Mailing Address F D 1524 Sd__7 Septic Tank ✓or Cesspool t-- Brief iBrief Description of Proposed Construction or Alteration Loruye�� P � 2�2.o cj 1"L Location of Proposed Construction/Alteration: GZo 1MAw V"� DeP�k Owner of Property: V4 i!2y 1h IJ Owner Mailing Address: ZOq A<L-' Owner Property Address: Name and phone number of contact person Tax Map No:1000 Section 119Z Block p Z Lot Cross Street VKR!2�_ L.� NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY MHEAL H DEPARTMENT APPROVAL Signature of Applicant Date Received by: SI NORTH ROAD) SCl ROU7MAIN AKA zor EXI' (AK EXI'EXI' N RTE. 25 (A __.__.— — SITE LOCATION KEY MAP NTS I ' OVER Y: 1wA if. {fl �ORNN rMWFgLE COWR m SAP .46 GR( O �- 50 % ® RQ EXPANSIO st �� POOL 46, UNFNSED CELLAR"NO STORADE A`; kQ MECNNVIC.:;. ONLY .VA 0 Y CY FF ELY. L Y � X • a 9 a r J 0 J• ♦,O ♦ qJ�p'! d e 4' + a. r., U L1 Q � � O T SANITARY DENISTY CALCULATION n= Z 464AC X 600 GPD/AC = 278.40 ALLOWED GPD C16. N GROUND WATER ZONE IV O W I Q .� rn N u7 O C N ALLOWED: 600 GPD/ACRE o � G .464 AC = 278.40 GPD LL+ L1-1 PROVIDED GPD = 195.04 o i I— PROVIDE MINIMUM SYSTEM o. �. 1200 GAL SEPTIC TANK 8' DIA X ole 00 O 4' LIQUID DEPTH & (1) 10 X 12 LP o., r N PROPOSED NEW SEPTIC WILL o0 BE LOCATED THE REQUIRED ^ ' DISTANCES FORM PUBLIC WATER ` V Z LINES, DRAINAGE LEACHING Q POOLS, ETC. AS REQIRED BY SCHD SANITARY CODE. L<� CD N CV Z 00 Q O O N n J to lL ' LL. W w � 1a a 0 0 V/ M 0) r °1talk rti -1;( tic UI O U M Abandonment of existing sanitary system must be in conformance with department requirement Submit 4 completed form WWM- 9 as proof • z CC .� G ~ . o ' a_ ' rtmem of Health Serviom Suffolk County Dopa �1` Approval for Constructiot'-Other Than Siegle Family VJ V Plow ,u n RefdenceNo 00 roo/ DeaiWt 0 ,� p L3 The(�� These p shave beat revs far genaal con nee with Suffolk m County Department of Health Services standards,relating Io water supply o and sewage disposal Regardless of any omissions,inconsistettas or lack rl of detail,construction is required to be in accordance with the attached permit conditionand applicable standards�rem the approv cly onditions by the Department. This approval expires 3 y unless extendedorrenewed. --- i 3i ZU/ Reviewer No. pp el Date SHEET SCHD REF . # CIO , - 09 - 0001 __ f- 1 SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4420-N Residential Non-Residential X Fee $ 25.00 New X Existing Name Of Owner MIKE OWEN ------------------------------ Mailing Address 1 205 EDWARD AVENUE ------------------------------ Mailing Address 2 City St Zip CALVERTON NY 11933-0000 Property Address 1 29205 MAIN ROAD ------------------------------ Property Address 2 ------------------------------ City St Zip CUT CHOGUE NY 11933-0000 -------------------- -- ---------- Owner Telephone No. 631-369-7310 ------------ Tax Map No. section 102.00 block 2 lot 12.005 ------ --- ------ Cross Street DEPOT LANE ------------------------------ ---------------------------------- Issue Date: 8/20/10Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) TPvol 102 - Z - owe PHONE: 631-878-3802 16BAYAVENUE E. MORICHES,NY H FAX 631-208-1681 Suffolk County Department of Health Services Office of Wastewater Management Suffolk County Center Riverhead,New York 11901 (631)852-2100 CERTIFICATION OF SEWAGE DISPOSAL SYSTEM BY INSTALLER Health Department Reference Number: C 10 — 09 - 0 C)o I Suffolk Tax Map#: Dist: —Sect(s) 10a ,00 Blk(s) Lot(s) 12 , Project Name or Address: Subdivision Name&Lot -A9 ;L 05 K A i I-*> -R®P-,1) 0,Q 1-614 0 Co,U Applicant's Name: f K Ov-1157 Description of System Installed: Septic Tank Volume(gallons) ISno Shape: []Rectangular [� Cylindrical Name of Precast Manufacturer: DIAMOND PRECAST Leaching Pools Number of Pools Diameter and Depth X Name of Precast Manufacturer DIAMOND PRECAST Other: Attach or sketch below the measurements from building comers to the access covers of disposal system. AL------------ f�- OO 61c.. 14 W 99,-7 I hereby certify that the subsurface sewage disposal system,described herein,has been installed by me in accordance with the approved plans and standards of the Suffolk County De Seices;and is operational. Installer Signature: Date: Cz-9g Print Name/Company: TED SMITH EXCAVATING Phone: 631-878-3802 Consumer Affairs License Number: 213-W This certification shall not be used in lieu of inspections required by personnel of the Department and may be duplicated on company letterhead,provided it contains the above information. O��S�FfO�,�►coG ELIZABETH A.NEVILLE C2 y� Town Hall, 53095 Main Road TOWN CLERK 2 P.O. Box 1179 REGISTRAR OF VITAL STATISTICS O Southold, New York 11971 MARRIAGE OFFICER *4 • �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER- Ol �a Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 V Application No.Li q Permit No. Owner Name Owner Mailing Address 905 ET�w 67—b ME Owner Property Address299C.5- M A I I,� FOA� (-t-)TGf-/(3 0 *O-Y Owner Telephone No. la3 f - 3(,o9 --7 3 I o Tax Map No: Section 109,00 Block of Lot l oZ, C70� Cross Street- Dr=po-T Lam. Please check each that applies: New Construction Alteration to Existing System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SC approval.) ignatof Applicant Date Received by: CAX ure /1°, J/ rd 1 '-j' a ��• / OF ,Qe 50-4 ° d d . e e 4, � e e d .7&4' 7 caLER b Z qNp oo S Q o`p F, °SO°o / ,V O�\ b. /\\ � 'y �, /3�. `' sem° �c5' / •stp, �' C _, H FF Env. �� Os �� u'v, y o•P �° Q/ ,ti X O��• oopk \�\ o Q� FY 5° 2� SE` _ 0 OVEt?F1EA�WIRES 0 .0 v OQ \/ ROp Coy n�^� O ti. Q° % e�� / p a de pip, ,JPq \!� ' 'lam /• e a •d, O d -- e d ° ° d YY d 9 A4 e ° a ®��OF S®UTA®� ELIZABETH A. NEVILLE,RMC, CMC '` ® Town Hall, 53095 Main Road TOWN CLERK P O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER a0 Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERl " . Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �C®UNri,� south oldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3952 N Residential Non-Residential X Fee $ 25.00 Septic X Cesspool PERMIT ISSUED TO: Name : CHARLES THOMAS Address 1: P 0 BOX 91-7 City St Zip JAMESPORT NY 11947 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF ##C10-09-0001. FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT. Name Of Owner MIKE OWENS ------------------------------ Mailing Address 1 205 EDWARDS AVE ------------------------------ ------------------------------ City St Zip CALVERTON NY 0000 -------------------- -- ---------- Property Address 1 29205 MAIN ROAD ------------------------------ ------------------------------ _City St Zip CUTCHOGUE NY 11935 -------------------- -- ---------- Tax Map No. section 102.00 block 2 lot 12.005 Cross Street DEPOT LANE ------------------------------ Building Permit Number Cross Reference: F o �� ---------------------------------- Issue Date: 5/25/10Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL)